Health Care Delivery/Clinical Practice

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Use of health services in the United States stays fairly constant over 40 years

Despite substantial changes in the organization and financing of health care in the United States, the estimated monthly use of health care services by Americans has remained remarkably consistent over the past four decades, according to a new study supported by the Agency for Healthcare Research and Quality.

In updating a landmark 1961 study by Kerr White, M.D., researchers led by Larry A. Green, M.D., of the Robert Graham Center in Washington, DC, found that in an average month, 800 of every 1,000 American men, women and children experience health-related symptoms, 217 visit a physician, and 8 are hospitalized. Fewer than 1 per 1,000 is admitted in a month to a teaching hospital. These figures are similar to Dr. White's earlier estimates that in an average month, 750 of 1,000 adults experienced an illness, 250 sought care from a physician, 9 were hospitalized, and 1 was referred to a teaching hospital.

The research team, which included David Lanier, M.D., of AHRQ's Center for Primary Care Research, based its estimates primarily on data from AHRQ's 1996 Medical Expenditure Panel Survey (MEPS), which tracks the health care use of a nationally representative sample of noninstitutionalized Americans. Other data sources, including a Gallup Survey conducted in April-May, 2000, were used to estimate the number of people who considered seeking health care and those who received care from a provider of complementary or alternative medicine.

According to the researchers, these findings reconfirm that the majority of medical care experienced by most Americans occurs outside hospitals. The findings suggest that researchers, educators, and clinicians should strive for a more balanced view of the "ecology" of health care. For example most measures of the quality of health care that are currently in use were developed for hospital settings, and much of the recent interest in medical errors has focused on the safety of patients in hospitals. As Dr. Green and his colleagues point out, the ecology model highlights the opportunities that would be missed by limiting quality and safety programs to hospitals. They call for comprehensive medical information systems that span all sites of care.

For details, see "The ecology of medical care revisited," by Dr. Green, George R. Fryer, Jr., Ph.D., Barbara P. Yawn, M.D., and others in the June 28, 2001, New England Journal of Medicine 344(26), pp. 2021-2025.